The Potential Health Care Financial Burden for Massachusetts Residents under the ACA and the Revised BCRA

Abstract

We have prepared 31 state-specific analyses, comparing net premiums plus deductibles and net premiums plus deductibles as a percentage of income in 2020 under the Affordable Care Act (ACA) and the revised Better Care Reconciliation Act (BCRA) introduced in the Senate on July 20, 2017. BCRA would significantly broaden age rating in the nongroup market and would reduce premium tax credits for older adults, so we use a single 60-year-old adult as our example to capture the implications of those changes.

We present findings by rating region in each of the 31 Medicaid expansion states for our example person at four income levels: 100 percent, 200 percent, 300 percent, and 400 percent of the federal poverty level (FPL). In addition to changing premium age rating and computation of premium tax credits, eliminating tax credits for people with incomes between 350 and 400 percent of FPL, and phasing out the enhanced Medicaid matching rate for states that expanded eligibility, BCRA would eliminate the ACA’s cost-sharing reductions, which lower premiums and other cost-sharing requirements for tax credit–eligible people with incomes below 250 percent of FPL. These changes would lead to higher household financial burdens for net premiums and deductibles for those purchasing nongroup marketplace plans.